reply to jennifer
Comprehensive exams in women’s health need toAs with any assessment, the chief complain is often what drives what our questions are and what clinical pathways we explore. With women’s health that approach is not any different, as we need to explore the “what was”, “what is” and “what will be” for the patient. The comprehensive assessment is one that is longer in nature and normally saved for the first visit, as if this patient will be a returning patient a more focused examine comes during their following appointments. The follow is a “blanket” comprehensive assessment that can be tweaked for any patient (Elson, 2008);Chief complaint (is this a focused complaint or a first meeting or annual meeting)History of present illnessMenstrual HistoryAge at menarcheLast menstrual periodMenstrual characteristicsLengthHow long is flowAmount of flowOther symptoms? (breast tenderness, pelvic pain, etc)5Pain?Intermenstrual bleedingPerimenopause/menopauseBleeding patternVasomotor symptomsContraceptionCurrent method; is it working?Previous method; any complications and reason for changeCervical and vaginal cytologyResults and date of most recent papHx of abnormal paps? Why? Treatment?InfectionsHx of STD?Hx of vaginitis (types, frequency and treatment)Hx of PIDFertility/infertilityAny desire for future?Difficulty conceiving? Treatments in past?Sexual hxTypeConcerns about libido, orgasm, dyspareuniaAny hx of abuse? Assault?Obstetric hxDescribe each pregnancy and outcomeAny maternal, fetal or neonatal complications?Past medical historyCurrent and past illnessesHospital admissionsSurgical hxGYN and Non-gynMedications/allergiesOTC, prescribed, herbalAllergies to meds, food, environment and reactions?Family hxSignificant illnesses of familyHereditary concernsSocial hxRelationship statusLevel of educationOccupationR.O.S.Abdomino-pelvicGYNGIGUBreastOthers18.Health MaintenanceSmoking, alcohol use, drug useDietSupplement intakeExerciseRegular screenings (mammo, pap, colonoscopy)Immunizations and datesHealth maintenance is very important for all ages when related to women’s health. The following are some ideas of health maintenance for each age group (Well-Woman Recommendations, 2018);AdolescentsIf sexually active the patient should have discussion with provider on sexually transmitted diseases and contraceptive useDrugs and alcohol usePeer pressure with sexual situationsChildbearingAnnual blood work to identify challenges in anemia, TSH, Cholesterol and minerals.Breast self-awarenessReproductive health planImitate partner violencePeri-menopausalHormone therapyMammogramsAdvance directivesProblems with sexual encounters (pain, dry, etc)MenopausalSleep patternsChanges of the body (hair growth, hormonal changes, sexual changes)Breast self-awarenessGeriatric WomenSexual functionInjury preventionNeglect/abuseElson, N. B. (2008, July). The Gynecologic History and Examination. Retrieved from The Global Library of Womens Health: https://www.glowm.com/section_view/heading/TheGynecologicHistoryandExamination/item/3#3521Well-Woman Recommendations. (2018, January 5). Retrieved from The American College of Obstetricians and Gynecologists: https://www.acog.org/About-ACOG/ACOG-Departments/Annual-Womens-Health-Care/Well-Woman-Recommendations?IsMobileSet=false
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